A 64 year old woman presents to the emergency department with dyspnea. On exam she is mildly tachypneic, has an oxygen saturation of 94% on 2L nasal prongs, and bilateral crackles to auscultation. You suspect acute heart failure and wonder about the role of lung ultrasound as you await her chest x-ray. Clinical question: What is the sensitivity and specificity of lung PoCUS compared to chest radiograph for diagnosis of acute decompensated …
Clinical Question: Can stable patients presenting to the emergency department with blunt abdominal trauma be managed safely without a CT scan?
You are working in a rural Emergency Department (ED). You assess a 25-year-old male patient who crashed his car into a tree. Vitals are normal and GCS is 15. Airway is patent and protected. There is bilateral chest rise, no abdominal tenderness or seatbelt sign. Pelvis is stable, and you notice some swelling over his right wrist. What is Blunt Abdominal Trauma? Blunt abdominal trauma is an injury to the abdomen without an …
Clinical Question – How Do I Approach Agitation and Aggression in Children with Autism Spectrum Disorder in the Emergency Department?
A 7-year-old boy with autism spectrum disorder presents to the emergency department (ED) with upper respiratory infection symptoms. He starts becoming agitated as you try to auscultate his lungs and aggressively comes towards you. You are unsure of the best method to approach this situation. Research has demonstrated that almost one third of children with autism spectrum disorder (ASD) who present to the emergency department had negative experiences or unwanted outcomes.1,2 Children with …
Clinical Question: When should patients be allowed to eat in the Emergency Department?
You have just finished seeing a 12-year-old boy who fell off the monkey bars about an hour ago. He has an obvious deformity to his right elbow and you suspect a displaced fracture that will require reduction. You would like to use procedural sedation to facilitate the reduction, but an empty granola bar wrapper stops you in your tracks. “We missed dinner rushing here and he couldn’t resist,” his mom says. Staring at …
Clinical Question: What is the Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain?
Clinical Question: Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain A 73-year-old male presents to your Emergency Department with vague LLQ abdominal pain. Your differential includes stones/pyelonephritis, diverticulitis, obstruction, and neoplasm. You want a CT scan to assist in diagnosis. A colleague mentions you need oral contrast to diagnose obstructions, and intravenous contrast to diagnose diverticulitis but intravenous contrast hinders the diagnoses of stones. What is the …
What is the role of POCUS to differentiate between cellulitis and abscess?
A 30-year-old male presents to the ER with right forearm redness, swelling and pain. On exam, you are unsure whether this infection represents cellulitis or abscess. You wonder if point-of-care ultrasound (POCUS) can be helpful. Superficial soft tissue infections are a common ED presentation. Cellulitis appears as an area of erythema, edema and tenderness. An abscess is suspected when a discrete fluctuant mass is palpated within the infected tissue. However, relying on these …